Article summary with Childhood Maltreatment, Borderline Personality Features, and Coping as Predictors of Intimate Partner Violence by Krause-Utz a.o. - 2018

Introduction

Violent or coercive acts committed by one partner against the other, either in an existing or past relationship, is called intimate partner violence (IPV). Intimate partner violence is globally regarded as a serious physical and mental health concern. In the United States, around 15 to 35% of women and 20 to 25% of men, have experienced one or more forms of psychological, physical and sexual intimate partner violence. The consequences of intimate partner violence can persist over a lifetime. Sometimes this kind of violence is even deadly. For example, intimate partner violence is the main way in which people get murdered. It is also a risk factor for suicidal attempts and it can lead to other outcomes such as an increased risk for depression, anxiety disorders, posttraumatic stress disorder (PTSD), substance abuse and personality disorders. These conditions are not only an outcome, they can also serve as a risk factor for intimate partner violence.

Because of the negative consequences, high prevalence and complexity of intimate partner violence, it is important to determine risk factors and contributing factors. 

Previous studies have shown that childhood maltreatment, such as abuse and neglect, increase the risk for perpetrating and/or being a victim of violence in close and intimate relationships in adulthood. However, the studies that have looked at this intergenerational transmission, have only reported low to moderate effect sizes. This means that growing up in an abusive environment is not the whole story. Therefore, identifying risk factors for experiencing intimate partner violence, can help in the prevention and treatment of it. The authors of this article suggest that features of borderline personality disorder (BPD) and maladaptive coping may be important in this relationship.

The features of borderline personality disorder such as affective instability, disturbed sense of self, unstable identity, interpersonal disturbances and self-harming impulsivity, are often seen as the consequence of maltreatment during childhood. These features are also positively related to intimate partner violence. 

Even though the symptoms of borderline personality disorder often decrease over time, interpersonal problems and difficulties in establishing meaningful relationships, persist. Often interpersonal stressors such as real or perceived social rejection and abandonment are triggers of emotional distress in people with borderline personality disorder. For instance, increased emotional distress due to rejection sensitivity, separation concerns, fear of abandonment and intolerance of being alone, may lead to impulsive aggression in individuals with borderline personality disorder.

The current study

However, it is not clear if a combination of borderline personality features and childhood trauma lead to intimate partner violence. Multiple studies have reported a link between borderline personality disorder and intimate partner violence, but in most of these studies, the focus was on intimate partner violence perpetration. So, it was only looked at whether having borderline personality features and having experienced childhood trauma leads to higher perpetration of violence. However, there are two forms of intimate partner violence: perpetration and victimization. The authors of this article suggest that these forms may co-occur, but that the underlying mechanisms may not be the same. For instance, maladaptive coping during stress may be one of the underlying mechanisms, especially in individuals with borderline personality disorder. These individuals often lack effective coping strategies and problem-solving skills.

It is also not clear whether gender plays a significant role in this relationship. For instance, men are thought to perpetrate forms of intimate partner violence which may lead to physical injury, more often than women. In borderline personality disorder, intense anger and impulsive aggression are more prominent in men. Another study found that borderline personality features are related to both intimate partner violence perpetration and victimization in men. However, in women, borderline personality features are only related to victimization. 

So, previous research has revealed that there are relations between all of these factors. However, there has not been differentiated between perpetration and victimization in both genders. Therefore, the authors look at this. 

The current study looked at; whether borderline personality features mediate the relationship between childhood maltreatment and ipv perpetration and victimization; whether coping mediated this indirect effect and whether gender has a significant effect in this model. The authors also looked at whether anxious attachment affected the results, because previous studies suggested that attachment may be a confounder. The authors also looked at the direct effects of childhood maltreatment on intimate partner violence and at the indirect effects through borderline personality disorder and coping in female as well as male participants. They controlled for age and attachment style. The hypothesis was that childhood maltreatment would positively predict intimate partner violence and that borderline personality features would mediate this relationship. They also expected that the mediating effects of borderline personality disorder would be mediated by coping.

Materials and Methods

This study was conducted in the Netherlands, at the Leiden University. The participants were recruited through online platforms for victims of childhood maltreatment. 

The severity of childhood maltreatment was assessed using the Childhood Trauma Questionnaire. This is a self-report which assesses emotional, sexual and physical abuse and also emotional and physical neglect. Each of these scales consists of five items.

The borderline personality features were assessed using the Personality Assessment Inventory-Borderline Features Scale. This is a self-report which was derived from the Personality Assessment Inventory. It contains 24 items and contains four subscales: affective instability, identity diffusion, self-harm and negative relationships. Affective instability involves intense and unstable emotions. An example of an item measuring this subscale, is: "My mood gets quite intense and it can change shift suddenly". Identity diffusion refers to having an unstable self-image and sense of self. An example of an item measuring identity diffusion is: "My attitude about myself changes a lot". Self-harm refers to potentially self-damaging impulsivity. An example of an item which measures this, is: "I am too impulsive for my own good and I sometimes do things so impulsively that I get into trouble. When I am upset, I typically do things to hurt myself". Negative relationships refer to experiencing interpersonal disturbances, such as experiencing extreme fear of abandonment. An example of an item which measures this, is: "I worry a lot about other people leaving me. I can not handle separation from those close to me very well".

Intimate partner violence was assessed by means of the Conflict Tactics Scale-Revised. This is a questionnaire which contains 78 items. It contains pairs of questions, which refer to the self (perpetration) as well as to the partner (victimization). There are five subscales: Negotiation, Psychological Aggression, Physical Assault, Sexual Coercion and Injury. 

Coping was assessed using the Cognitive Emotion Regulation Strategies Inventory. It contains 18 items and measures cognitive emotion regulation strategies after one has experienced a negative life event.

Lastly, participants completed the Revised Adult Attachment Scale. This measures three dimensions: close, dependent and anxious. This scale measures the attachment styles of the participants.

Discussion

This study wanted to investigate the effect of childhood maltreatment severity on intimate partner violence perpetration and victimization. It also looked at the indirect effects, through borderline personality features and maladaptive coping. The study found a significant indirect effect through borderline personality features. So, having borderline personality features served as a mediator for childhood maltreatment and intimate partner violence. There were no indirect effects through coping. Gender also did not seem to have any significant effect.

Having experienced childhood maltreatment, especially emotional and physical maltreatment, may serve as a risk factor for perpetrating and re-experiencing violence in adult relationships. The authors also found strong significant relationships between all forms of childhood maltreatment and borderline personality features. In the current study, borderline personality features played a significant role in the relationship between the severity of childhood maltreatment and borderline personality features. To elaborate, the presence of borderline personality features seems to be an important risk factor for intimate partner violence.

Borderline personality features are related to higher rates of violence perpetration in marriages and more teen dating violence. The authors' findings suggest that individuals with borderline personality features may be at a higher risk for perpetrating and experiencing intimate partner violence. Borderline personality features may also be an important psychological factor which underlies the relationship between growing up in an abusive environment and experiencing intimate violence in adult intimate relationships. 

The specific borderline personality features were affective instability and interpersonal disturbances alone and in interaction with identity disturbance and self-harming, are risk factors for intimate partner violence perpetration. For victimization, interpersonal disturbances together with unstable self-image, were a significant factor for victimization. So, these results suggest that there are different psychological mechanisms. For example, adults who have experienced childhood maltreatment, may have come to learn that violence is normal for close relationships. Therefore, they may respond with helplessness when they are confronted with violence in intimate adult relationships. 

The authors controlled for anxious attachment and found the same results. This means that anxious attachment does not account for the observed findings.

In contrast with the hypothesis, coping was not identified as a significant psychological factor in the relationship between childhood maltreatment, borderline personality disorder and intimate partner violence. There was also no significant predictive effect for perpetration. This is in contrast with previous research, which has reported that coping with stress plays an important role in violence. In other words, previous research showed that individuals with a history of childhood abuse may have learned that violence is an acceptable strategy for coping with conflicts in close relationships. 

Also, previous research showed that aggressive and impulsive behavior in individuals with borderline personality features, are primarily present under emotional distress and may have to do with a lack of adaptive coping strategies. The authors explain that these inconsistencies may have to do with that in the present study, coping was measured using the CERQ. This focuses on cognitive coping strategies and might not look at difficulties in emotion regulation. Cognitive coping and emotion regulation are related, but it might be the case that other behaviors, such as problematic alcohol use, may be mediators of the relationship between borderline personality features and intimate partner violence. The authors suggest that impulsivity may play an important role.

Gender did not have a significant effect on intimate partner violence perpetration or victimization. However, previous research suggested that women and men are both equally likely to perpetrate and to be a victim of intimate partner violence. For example, some studies reported higher rates of intimate partner violence perpetration in women than in men. Females were also thought to experience a wider range of poor mental health outcomes. In line with these results, the authors of this article found that women report higher rates of psychological aggression and physical assault toward their partners. Male participants reported more sexual coercion. Reciprocal violence is the most prevalent form of intimate partner violence. In previous research, men with borderline personality disorder, showed more impulsive aggression, while women with borderline personality disorder, were more often victims of intimate partner violence. However, in the present study, gender did not play a significant role in this relationship.

There are a few limitations of the current study. First, because this study was a cross-sectional correlational design, no causal conclusions can be drawn. So, it is not clear if borderline personality features predate or follow intimate partner violence. Second, childhood maltreatment and other variables were assessed retrospectively and subjectively, so it could be that the participants' responses were biased. Also, individuals with higher levels of borderline personality features may be more likely to remember and report more severe childhood abuse, suffer more from traumatic experience and have more vivid negative memories. Also, half of the sample did not complete the survey, which might have led to selection bias.